Medical Billing Forum

Billing => Billing => Topic started by: ghello12 on December 05, 2017, 10:42:00 AM

Title: Does anyone currently bill Tricare for a behavioral health facility?
Post by: ghello12 on December 05, 2017, 10:42:00 AM
I'm new to the forum and currently bill for substance abuse and mental health facilities. I have a program that is looking to start taking Tricare clients. Is there anything that I need to know or be aware of as I get into Tricare billing? Any info helps! Thanks!
Title: Re: Does anyone currently bill Tricare for a behavioral health facility?
Post by: Michele on December 06, 2017, 09:49:58 AM
Are they in network with TRICARE?  TRICARE has Participating In Network, and non Participating in network.  It's important to know what they are.  Other than that it is similar to billing any other insurance.  I would recommend verifying benefits prior to treatment to make sure patient is covered, services will be covered, if auth is needed, etc.  They accept electronic submissions. 
Title: Re: Does anyone currently bill Tricare for a behavioral health facility?
Post by: ghello12 on December 06, 2017, 04:19:31 PM
It's an out of network facility. Do you just bill the standard H0018 code for residential? Or is there any different coding that you have used?
Title: Re: Does anyone currently bill Tricare for a behavioral health facility?
Post by: Michele on December 07, 2017, 07:34:21 AM
Are you billing for all inclusive room & board?  What services are you billing for?  I know it's substance abuse facilities but the H0018 is short term residential without room & board.  So in order to answer you I need to know what services.  For example, when you bill all inclusive room & board you use a rev code such as 0128, depending on whether its detox or rehab and the type of room.

Have you ever completed UB04s?  They are a bit different.
Title: Re: Does anyone currently bill Tricare for a behavioral health facility?
Post by: terimia on December 12, 2017, 12:37:12 AM
I am also looking for some info on biling tricare for inpt residential detox... We tried the rev code of 0128 and only got like 90.00 a day.  But if you look at website it says it will pay somewhere around 800 a day.  I was wondering if anyone bills for tricare on a ub form and what combination they are using? 
Title: Re: Does anyone currently bill Tricare for a behavioral health facility?
Post by: Michele on December 12, 2017, 09:59:58 AM
We have billed 0128 to TRICARE for residential inpatient.  0128 is Rehab, not Detox though.  $90 seems very low.  Have you called to speak to anyone at TRICARE?